Exam 9: Postoperative Patient Care and Pain Management

Evidence indicates that early analgesia reduces postoperative problems.Recent studies endorse the multimodal approach to both preemptive (preventative)and postoperative analgesia customized to patient needs based on meticulous preoperative assessment.Marin Summers,a 72-year-old physically active woman,was seen in the preoperative admission center in preparation for her total knee replacement surgery on Thursday.She has not had any opioid medications in her lifetime that she can remember.She has inflammatory bowel and gastric disease and was told she cannot take ibuprofen in any form.Select a multimodal analgesic treatment plan that would best serve Mrs.Summers' perianesthesia experience.

The initial primary assessment by the perianesthesia nurse,on the patient's admission to the PACU,begins with which criterion?

Wayne Freeman was admitted to the PACU spontaneously breathing through his endotracheal tube.Shortly after the perianesthesia nurse extubated Wayne,he stopped breathing and his color changed to pale,dusky-beige.What is the most ideal action that should occur immediately?

Hypothermia is a common side effect of surgery and the perianesthesia setting.Which of the following interventions is most effective in normalizing and maintaining body temperature? Select all that apply.

Select the treatment strategy for PONV that is considered a best practice in the perioperative and perianesthesia setting.

Select three appropriate components of the hand-off report from the perioperative nurse to the perianesthesia nurse as the patient is received in the PACU.

Hypotension is a blood pressure reading that is 20% less than the patient's normal baseline pressure.Hypovolemia is the most common cause of hypotension;however,hypotension may also be caused by cardiac dysfunctions.Which triad of cardiac conditions will present with hypotension?

The perianesthesia nurse completes a systematic and comprehensive secondary assessment of the patient (e.g.,head-to-toe assessment or major body systems' approach).Select the responses that best reflect the parameters of a comprehensive respiratory assessment.

Jason Snyder,a 46-year-old healthy male admitted for a diagnostic arthroscopy,was prewarmed in the preoperative holding lounge wearing a specialized patient gown with inlets for a forced air-warming device hose.After transfer to the OR bed,he was covered with an over-body adapted blanket of the same device.IV fluids cycled through a fluid warmer and the irrigation bags of sterile saline cycled through a warming device during the procedure.The perioperative nurse had preset the OR ambient temperature to 75° F.Select the statement that best reflects the justification for these practices.

Randall Preston,a 49-year-old healthy male,is beginning to emerge from general endotracheal anesthesia after a transurethral laser lithotripsy of the left ureter.He is restlessly turning side to side and moaning.During the hand-off report from the anesthesia provider and circulating nurse,the perianesthesia nurse learned that Randall will probably continue to pass "sludge" (small granular ureteral stone material)for the next hour.As the surgical team rushes back to the OR to start the next case,the perianesthesia nurse thanks them and tells them they can go as she knows what is wrong with Randall and will take care of him.The perianesthesia nurse's comment reflects which phase of the nursing process and what will be her next actions?

Select the appropriate example of physiologic symptoms of pain.

Select the statement below that best reflects the effects of hypothermia in the perianesthesia period.

Select the patient that is the most vulnerable and at high risk for hypothermia in the perianesthesia phase based on diagnosis or surgical procedure.

Virginia admitted that she had been straining while seated on the toilet and the anesthesia provider and perianesthesia nurse surmised that Virginia experienced a vagal response,which led to bradycardia and syncope (fainting).While Virginia feels weak and tired from her experience,she is eager to go home and pleads to be discharged.Her heart rate and blood pressure are less than 20% of her admission parameters;she is awake and lucid and is able to appropriately follow commands.Her incision and dressings are intact and her abdomen is soft.She claims that her pain is slight and tolerable.The nurse must now determine the next step in Virginia's recovery based on this recent evaluation.What phase of the nursing process will impact Virginia's next step and what can she expect?

Luci Edwards,a patient of Dr.Jordan,has been admitted to the PACU after a bilateral bunionectomy.During the hand-off report from the anesthesia provider and circulating nurse,Luci began to awaken,crying in drowsy garbled speech that she was thirsty and wanted water.What would be the perianesthesia nurse's appropriate response?

What parameters and questions will the perianesthesia nurse investigate while assessing neurologic status? Select all that apply.

Virginia Grier,a 33-year-old female who had a D&C with laparoscopic tubal ligation and has been in phase II recovery for 3 hours,collapsed while sitting on the toilet.The perianesthesia nurse had recently finished giving Virginia her discharge instructions and helped her dress.Virginia was assessed for loss of consciousness and ineffective breathing patterns and lifted to a transport vehicle.What action should the phase II nurse take next?

Laryngospasm is a common but serious complication in the immediate postoperative pediatric tonsillectomy and adenoidectomy patient.What is the ideal immediate and last resort response by the anesthesia provider or perianesthesia nurse in an emerging patient who has been in spasm for over 1 minute,is not responding to positive-pressure ventilation,and is in significant distress?

Daniel Powers,a 32-year-old developmentally delayed male scheduled for dental rehabilitation,became agitated on admission to the preoperative holding unit.In spite of sedation and the calming attention of the nurses and his parents,he was screaming and rapidly turning his head from side to side.He vomited and choked twice before he fell into a light but restless sleep.During the short procedure,the anesthesia provider was aware of rigidity and difficulty with ventilation in Daniel's chest,yet his oxygen saturation was between 96% and 100% throughout the procedure.On extubation,Daniel presented with coughing,wheezing,dyspnea,use of accessory muscles,and tachypnea.Daniel is presenting with probably caused by .

A key component of postoperative discharge instructions requires verification of patient/family understanding of the instructions.A recent study found that only 67% of the discharge instruction comprehension was retained by day 3 postdischarge.What strategy best ensures patient/family understanding and comprehension of the discharge instructions?